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836 Cavalla Rd-Roof Non-shingle s•-L`tr City of Atlantic Beach APPLICATION NUMBER ff f S, Building Department (To be assigned by the Building Department.) 800 Seminole Road pp,�,, G !a �r Atlantic Beach, Florida 32233-5445 �-00F�F p O O L( ��C Phone (904)247 5826 Fax(904)247 5845 �Js3 �r E-mail: building-dept@coab.us Date routed: d 1)-31 (1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: <63 .- - til Co CAA/q l`4 'd De artment review required Yes No Building Applicant: CP`l rY\--Q_ ( 03t- Css)(VV4AC {��5 oning (� -,f Tree Administrator Project: t L - ( vv}- -51AJ\ (-Q MOjccV 0 Public Works CAbut.)(‘ VLOv Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department I First Review: Approved. Denied. ❑Not applicable (Circle one.) Comments: BUILDIN PLANNING &ZONING Reviewed by: Date: MV,261k TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ['Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 1-:? (-- . CITY OF ATLANTIC BEACH ,5 _,0 800 SEMINOLE ROAD 4I. ATLANTIC BEACH, FL 32233 o13l>%' INSPECTION PHONE LINE 247-5814 ROOF NON SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: ROOF18-0016 Description: shingle & modified re-roof Estimated Value: 3012 Issue Date: 2/26/2018 Expiration Date: 8/25/2018 PROPERTY ADDRESS: Address: 836 CAVALLA RD RE Number: 171717 0280 PROPERTY OWNER: Name: REICH JOHN M Address: 1852 BEACHSIDE CT ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: PRIME ROOF CONTRACTING LLC Address: 13792 HERONS LANDING WAY APT 9 QA MARK ANDREW YOUNG JACKSONVILLE, FL 32224 Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. OFFICE COPY Building Permit Application v .,~ City of Atlantic Beach i� 800 Seminole Road,Atlantic Beach, FL 32233 ,' Phone: (904) 247-5826 Fax: (904)247-5845 Job Address: 836 CAVALLA RD Permit Number: (2 OUF( - 001 (p Legal Description 31-16 17-2S-29E.35R/P OF PT OF ROYAL PALMS UNIT 2AE 16.4FT OF W 38.94FT LQRTE5 BLK 26 Valuation of Work(Replacement Cost)$ 3,012 Heated/Cooled SF 1128 Non-Heated/Cooled 56 • Class of Work(Circle one): New Addition Iteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial (esidenti? • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 42, • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: Replace asphalt shingle roof i(1nLtk�,eci cn\ lid Florida Product Approval#FL10674-R12 (shingles) FL17420-R2 (felt) for multiple products use product approval form Property Owner Information FL2c? ?— Q-ACo CN`c . Name:22hIN REICH �( Q1,6L Address: 1852 BEACHSIDE CT. City ATLANTIC BEACH State FL Zip 32233 Phone 678-877-9942 E-Mail johnreich@vahoo.com Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young Address 13725 Beach Blvd Suite 13 _ city Jacksonville State FL Zip 32224 Office Phone (904) 530-1446 Job Site/Contact Number (904) 860-0230 State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com Architect Name&Phone# Engineer's Name& Phone# Workers Compensation FRSA Self Insurers Fund Inc. 1/1/18 870-040093/3EE6142 Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. • OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE REC RDI YOUR NOTICE OF COMMENCEMENT. • I (Signat e of Owner or Agent including Contractor) ignature of C111 ractor) S d and sworn to(or affirmed)before me this 2k{—day of Signed and sworn to or affirmed)t.+-fore me this ay of , ML, by_ M 'CAN ftGlet fllC,n ,by Al ._k___yllS ,41111! P ih-----• (Signature of Notary) (Signature of Notary) Andrew D. Davis iik. .� .( : �'�'�' B Andrew D. Davis .. 'a` 7a COMMISSION#FF160849 'rQ.. F sic N. =x ' • =_ COMMISSION#FF160849 [rersonall Known Oft �'��. EXPIRES: Sept. 17, 2018 Personal) Known OR = ✓t v �....� ['� v v�.,• ,. EXPIRES: Sept. 17, 2018 [ ]Produced Identificatiorf'�neW WWW.AARONNOTARY.COM [ ]Produced Identification '%,;�'oi ��` WWW.AARONNOTARY.COM /in tttttt Type of Identification: Type of Identification: NOTICE OF COMMENCEMENTO F F I C E COPY (PREPARE IN DUPLICATE) Permit No. Pend it Oen Tax Folio No. State of Florida County of Duval To whom it may concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved:31-16 17-2S-29E.35 R/P OF PT OF ROYAL PALMS UNIT 2A E 16.4F1OF W 3> Address of property being improved:836 CAVALLA RD Atlantic Beach FL 32233 General description of improvements:Re-roaf Owner JOHN REICH K(M Retcih Address 1852 BEACHSIDE Ci'ATLANTIC BEACH,FL 32233 Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name efr11Address ontractor Address Phone No. Prime Roof Contracting,LLC 13725 Beach Blvd Suite 13,Jacksonville,FL 32224 (904)625-1446 Fax No. • urety(if any) Address Amount of bond$ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements. Name Address Phone No. Fax No. Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Name Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER rI Sign A. .A _ L DATE_��' Before met's da of .(UN` in the County f Duval St ' o FI a.has personallya••eared �uu r `M f t q ��i�� r x by Andrew D. Daus himself;herself and affirms that all statements and decla 3ns/a,re O COMMISSION FF160849 Doc#2018043779,OR BK 18292 Page 2274, are true and accurate — Number Pages:1 .�� EXPIRES: Sept. 17, 2018 Recorded 02/23/2018 03:44 PM, %;FpFR;d�.� WWW,AARONNOTARY.COM RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL 8 COUNTY Not ry Public at Large.Stat f , County ofA RECORDING $10.00 My commission expires: _._ ._...__ Personally Known or Produced Identification